eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Femur: Follow-up

Author: James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
Contributor Information and Disclosures

Updated: Apr 22, 2009

Follow-up

Further Inpatient Care

  • Adults with a femur fracture are best treated with immediate operative fixation, typically intramedullary nailing.
  • Young children typically are treated with skeletal or skin traction for approximately 4 weeks, followed by a body spica cast.
  • Depending on the stage of skeletal maturity, some adolescents may be treated with initial external fixation, intramedullary nailing, or compression screw plate fixation.
  • In the presence of contraindications to surgery, this repair may be delayed for days without significant complications if leg length is maintained with traction.
  • Open fractures require immediate operative debridement followed by delayed intramedullary nailing.

Transfer

  • Transfer patients with femur fractures when the fracture is immobilized adequately. This is best accomplished with a traction device. As an alternative, use a pneumatic or posterior molded splint.
  • Reasons for transfer include the following:
    • Lack of appropriate orthopedic staff or operative facilities at the presenting center necessitates transfer.
    • Associated serious injuries, which are common, may require trauma center for ideal evaluation and management.

Complications

  • Hemorrhagic shock
    • Closed fractures of the femur can result in significant blood loss (eg, 1 L) within the thigh. Open fractures have the potential for even greater blood loss.
    • Because of the high rate of associated injuries, actively seek out other sources of blood loss in patients with femur fractures and hypovolemic shock.
  • Neurovascular injury
    • Injuries to the neurovascular bundle are rare because of the large cushion of muscle protecting neurovascular structures.
    • Compartment syndrome of the thigh does not occur often, and peroneal nerve contusion is seen occasionally.
  • Infection: While open fractures are at high risk of soft-tissue and bony infection, postoperative infection is rare following repair of closed fractures.
  • Respiratory demise: Fat embolism and adult respiratory distress syndrome (ARDS) can occur.
  • More delayed complications include permanent stiffness of the hip or knee, shortening of the extremity, or malrotation, resulting in permanent deformity and decreased performance.
  • Complications directly related to repair include (in order of increasing frequency) breakage of fixator hardware, nonunion, malunion, or delayed union.
  • Finally, refracture has occurred at the initial injury site.

Prognosis

  • Patients who survive the initial trauma associated with the injury typically heal well. Early mobilization following intramedullary nailing greatly reduces complications associated with prolonged immobilization.
  • Age affects the speed and quality of recovery. Fractures may be caused by underlying medical conditions such as osteoporosis or cancer metastasis; these conditions may complicate recovery further.
  • Patients older than 60 years with closed fractures of femur have a mortality rate of 17% and a complication rate of 54%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to conduct a careful assessment to exclude other, potentially life-threatening, injuries in the presence of femur fracture, which generally denotes high-energy trauma
  • Failure to consider the possibility of child abuse in young children
  • Failure to reduce and stabilize angulated femur fractures as soon as possible to minimize neurovascular injury and hematoma formation
 


More on Fracture, Femur

Overview: Fracture, Femur
Differential Diagnoses & Workup: Fracture, Femur
Treatment & Medication: Fracture, Femur
Follow-up: Fracture, Femur
Multimedia: Fracture, Femur
References
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References

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  2. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. Nov 1996;7(6):612-8. [Medline].

  3. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop. May-Jun 1997;17(3):342-6. [Medline].

  4. Braten M, Helland P, Myhre HO, Molster A, Terjesen T. 11 femoral fractures with vascular injury: good outcome with early vascular repair and internal fixation. Acta Orthop Scand. Apr 1996;67(2):161-4. [Medline].

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  8. Hogan TM. Hip and femur. In: Hart RG, Rittenberry TJ, Uehara DT, eds. Handbook of Orthopaedic Emergencies. Publishers: Lippincott Williams & Wilkins; 1999:307-8.

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  17. Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma. Jan 1996;40(1):17-21. [Medline].

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Further Reading

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Keywords

femur fracture, femoral diaphysis, fractures of the femoral diaphysis, femoral shaft fractures, spiral femur fractures, transverse femur fractures, comminuted femur fractures, open femur fractures, diaphyseal fractures, hip fractures, ligamentous knee injuries

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Contributor Information and Disclosures

Author

James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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